There is an African proverb that says ''To be pregnant is to have one foot in the grave''. The same can be said for a 38-year-old mother of four from an island province in Papua New Guinea. On April 17, 2007, in a small room in the village of Miwa in Milne Bay Province, Ruth Emmanual, went into labour.
At 2.30am, after 8½ hours, Ruth delivered her fifth baby in the presence of two other village women. Once the baby had been born, Ruth and her two companions waited for the placenta to come out before cutting the umbilical cord - as was their village custom.
Thirty minutes passed, and the placenta had still not been delivered.
Ruth became more and more breathless and the women desperately begged her to push. But she was too weak to even try.
Had Ruth been in a hospital with a trained maternal health professional, a procedure called a ''controlled cord traction'' would have been administered to manually remove the placenta. No such procedure was undertaken, and by 3am, Ruth uttered what would be her last words: ''I'm OK.'' By 4.45am, the 38-year-old woman lay speechless and her husband Emmanuel, realised his wife was anything but ''OK''. Panic set in, but he decided to wait for daybreak to come before getting help. Ruth breathed her last breath at 5am.
In the coming weeks it would be established that Ruth had died from primary postpartum hemorrhage - a loss of more than 500 millilitres of blood from the genital tract within 24 hours of delivery, and the biggest cause of maternal mortality globally. But the grim reality is postpartum hemorrhage is almost entirely manageable in a healthcare facility with even the most basic of training for birth attendants. Sadly, Ruth's story is not uncommon. Investigations in the Milne Bay Province into the deaths of 31 women over two years found that 30 of these deaths could have been averted. In this remote part of PNG, only one in six mothers chooses to deliver in a health facility and the decision to stay in a village without a skilled professional greatly increases her risk of death or severe injury.
Being a pregnant woman in PNG instantly places you at a risk 242 times greater of losing your life in childbirth than if you were having your baby just kilometres away in Australia. What's more, the United Nations estimates that 1000 women die each day from pregnancy-related causes - most of which could have been avoided with the most basic of care or facilities.
Not surprisingly, 99 per cent of these deaths occur in developing nations. The ongoing consequences are devastating. When mothers die, they leave more than one million children behind each year. Children who have lost their mothers are up to 10 times more likely to die prematurely than those who have not. In stark contrast, fewer than one in 20,000 Australian women die in childbirth.
So what is the world doing? One of the United Nations' Millennium Development Goals is to reduce maternal mortality by 75 per cent between 1990 and 2015. In 2008, new figures showed improvements with a drop in the maternal mortality rate of 34 per cent. But progress is achingly slow and has not been realised everywhere - especially PNG.
In 2010, Canberra obstetrician and Australian National University Medical School Professor Steve Robson was flying home from a conference. As he thumbed through the pages of Time Magazine on the plane, he was drawn to a photo essay by international human rights photographer Lynsey Addario on the tragic death of 18-year-old Mamma Seesay while she gave birth to twins in Sierra Leone. Sierra Leone has the ignominious title of being the most dangerous place in the world to give birth. One in 10 mothers will die.
It struck Dr Robson that in more than 20 years of delivering babies, he had never lost a new mother to bleeding. Shocked at the continuing toll of preventable death during childbirth in countries where women have little to no access to midwives, doctors or even sanitary places in which to give birth, he decided to do something to mobilise funds and public support for the biggest killer of women of child-bearing age.
Each day on his hospital rounds at John James Memorial Hospital, Dr Robson watched new mothers receive bunches of flowers - many of which were discarded when a mother and her baby went home. He wondered if the money spent on a bunch of flowers could instead go towards helping more women around the world, like Ruth, give birth safely?
Dr Robson gathered together a small group of like-minded people - all working in a range of fields but eager to put their skills to the cause of reducing maternal deaths. The charity Send Hope Not Flowers was born.
Send Hope Not Flowers partners with established groups such as the Pacific Society for Reproductive Health who work throughout PNG and the Pacific to prevent women dying in childbirth.
Having launched in Canberra just last month, Send Hope Not Flowers has received significant local interest and enough money to begin its first trial of potentially life-saving interventions in PNG. Along the way, it has received interest from community and maternal health groups in the United States, Britain and New Zealand to transport the model there.
Ruth's story is common. And it reminds us that women dying in childbirth is one of the most pressing needs of our time. This year's International Women's Day presents us with an opportunity to consider one of the most shocking losses there is - a mother in childbirth. It is a shocking loss because it is so common - a mother dies every 90 seconds around the world. But it is also shocking because it is so easily prevented.
Julie Ulbricht is a freelance writer and ambassador for the Global Poverty Project. She is one of the founders of Send Hope Not Flowers.
Emma Macdonald is the Canberra Times education editor and a co-founder of Send Hope Not Flowers.